Division of Primary Care and Population Health, University College London, UK.
Institute of General Practice, University of Marburg, Germany.
Age Ageing. 2023 Aug 1;52(8). doi: 10.1093/ageing/afad166.
The PRomoting Activity, Independence and Stability in Early Dementia (PrAISED) study delivered an exercise and functional activity programme to participants living with dementia. A Randomised Controlled Trial showed no measurable benefits in activities of daily living, physical activity or quality of life.
To explore participants' responses to PrAISED and explain why an intervention that might be expected to have produced measurable health gains did not do so.
A process evaluation using qualitative methods, comprising interviews and researcher notes.
Data were collected in participants' homes or remotely by telephone or videoconferencing.
A total of 88 interviews were conducted with 44 participants living with dementia (n = 32 intervention group; n = 12 control group) and 39 caregivers. A total of 69 interviews were conducted with 26 therapists.
Participants valued the intervention as proactively addressing health issues that were of concern to them, and as a source of social contact, interaction, information and advice. Facilitators to achieving positive outcomes included perceiving progress towards desired goals, positive expectations, therapists' skills and rapport with participants, and caregiver support. Barriers included: cognitive impairment, which prevented independent engagement and carry-over between sessions; chronic physical health problems and intercurrent acute illness and injury; 'tapering' (progressively infrequent supervision intended to help develop habits and independent activity); and the COVID-19 pandemic.
Self-directed interventions may not be appropriate in the context of dementia, even in the mild stages of the condition. Dementia-specific factors affected outcomes including caregiver support, rapport with therapists, availability of supervision, motivational factors and the limitations of remote delivery. The effects of cognitive impairment, multimorbidity and frailty overwhelmed any positive impact of the intervention. Maintenance of functional ability is valued, but in the face of inevitable progression of disease, other less tangible outcomes become important, challenging how we frame 'health gain' and trial outcomes.
在早期痴呆症中促进活动、独立性和稳定性（PrAISED）研究中，为患有痴呆症的参与者提供了一项锻炼和功能性活动计划。一项随机对照试验显示，日常生活活动、身体活动或生活质量没有可衡量的益处。
探索参与者对 PrAISED 的反应，并解释为什么一项可能产生可衡量健康收益的干预措施没有产生这种效果。
使用定性方法进行的过程评估，包括访谈和研究人员的笔记。
数据是在参与者的家中或通过电话或视频会议远程收集的。
对 44 名患有痴呆症的参与者（干预组 n=32；对照组 n=12）和 39 名照顾者进行了总共 88 次访谈。对 26 名治疗师进行了总共 69 次访谈。
参与者非常重视该干预措施，因为它主动解决了他们关心的健康问题，同时也是社交接触、互动、信息和建议的来源。实现积极结果的促进因素包括感知朝着期望目标的进展、积极的期望、治疗师的技能和与参与者的融洽关系，以及照顾者的支持。障碍包括：认知障碍，这阻止了独立参与和会话之间的延续；慢性身体健康问题和并发急性疾病和伤害；“逐渐减少”（逐渐减少的监督，旨在帮助养成习惯和独立活动）；以及 COVID-19 大流行。
即使在疾病的轻度阶段，自我指导的干预措施也可能不适合痴呆症患者。与痴呆症相关的因素影响了包括照顾者支持、与治疗师的融洽关系、监督的可用性、激励因素以及远程交付的局限性在内的结果。认知障碍、多种合并症和虚弱的影响超过了干预措施的任何积极影响。保持功能能力是有价值的，但面对疾病的不可避免进展，其他不太明显的结果变得重要，这对我们如何构建“健康收益”和试验结果提出了挑战。
